Posts Tagged capsular contracture
A short video shows a 27 year old ruptured silicone gel implant and the calcified scar capsule the patient’s body made to try to contain it. It helps explain why some silicone breast implant patients develop rock hard breasts and what can be done to fix the situation.
It also helps explain why most often I prefer saline-filled breast implants that do not tend to encourage the formation of rock hard breasts. Seeing calcium deposition on the implant capsule (which is what makes the breasts really hard) in a woman who has never had silicone gel implants is extremely rare.
John Di Saia MD
Originally posted 2011-05-30 07:30:13.
Low Maintenance Breast Implant
Surgery – Is this achievable?
I am looking into getting breast implants but want to keep redo surgeries to a minimum. Some of my friends have had 2-3 boob jobs in ten years, so I am not going to their doctor. I saw a few of your patients online saying that the implants you put in they kept for ten years. I want to get a worry-free boob job?
Thanks for the compliment.
There are several things you can do to reduce your risk for the need/desire for re-operation after breast implant surgery:
(1) Have surgery by a good qualified surgeon. In my book, that means a good ABPS board-certified plastic surgeon.
(2) Request guidance from your surgeon regarding the volume to which you can go safely. The leading cause of poor outcomes with implants that I see is the placement of implants too large for a woman’s available soft tissue coverage. Good surgeons know this although many fear “losing the case” if they share their concerns.
(3) Choose saline-filled implants and have them placed beneath your pectoral muscles. Silicone gel is another option but I feel the breast hardening rate (capsular contracture} is higher with them. Capsular contracture is also higher in some other cases that you may want to review before surgery.
(4) If you have any degree of breast sag, talk about breast lift surgery as an option before you have your operation.
John Di Saia MD
Originally posted 2011-04-22 07:30:34.
I have had a capsulectomy due to capsular contraction, but now it has returned. I want an explant because they are uncomfortable and look unnatural. My doctor said that since the capsulectomy did not resolve the issue, he recommends having an explant and waiting about 6 months to a year. After my body has healed properly, he said that I can get implants again and will not get capsular contraction again. Is this accurate? Am I less likely to get capsular contraction or will I be free of capsular contraction? I’m also looking for a doctor experienced in explants.
The subject of hardened breast implants (Capsular Contracture) comes up frequently as it is the leading cause of long term dissatisfaction with breast implants. If your breasts tend to hurt or look unnatural, you likely have severe encapsulation (Baker Grade III or IV.) When contracture redevelops quickly after capsulectomy (assuming the operation was thorough,) this is worrisome as it may indicate a high tendency for recurrence. The main question when severe contracture is present is whether or not a cause can be identified. Bothersome contracture doesn’t happen to all patients. This kind of reaction is associated with cigarette smoking, bleeding, infection, silicone gel implants, poor soft tissue coverage and radiation exposure as well as a previous history of contracture. Some of these issues can be minimized in an attempt to reduce the tendency for encapsulation. Preventing the problem is the best solution.
While removal of your implants for a time with later replacement might improve the problem, this is not a “slam dunk” nor is it guaranteed to completely solve it. The results vary substantially. Usually removal with a good capsulectomy is the best thing for comfort. Implant replacement at times is thwarted by recurrence of the contracture.
Then again if you leave the implants in place things will not likely improve as you have had a trial of capsulectomy and replacement already. It is true however that a woman who has had her implants removed and not replaced frequently has them put in once again down the road due to appearance issues. This is not invariably the case however. Some women actually like the look of their breasts without implants after capsulectomy and explantation. The results of such surgery vary though.
These cases need to be handled individually and with a fair amount of disclosure before surgery is performed, so that everyone comes out satisfied. I don’t have one treatment that goes for all patients on the issue due to their inherent variability.
John Di Saia MD
Originally posted 2011-05-31 07:30:35.
Beauty and The Breast (a blog that later went offline) blogged on my Silicone Implant Position Post. They placed a picture of a Saline-filled implant explantation specimen with what appeared to be thick capsules seemingly to say “see this happens with saline implants too.” The capsule pictures they showed were kinda low resolution but did not seem to have calcium deposits.
Maybe I need to clarify this a bit. The process of capsular contracture happens with all foreign bodies placed into the body. The body makes a capsule with all breast implants silicone and saline. The question when such a device is placed is not whether it will occur but how can we make it occur to the least extent.
Things that can make capsules worse (generally thicker) include:
(1) Bleeding and/or Trauma
(3) Poor or Thin Soft Tissue Coverage
(5) Radiation therapy
and arguably Silicone Gel.
Now why the Silicone Gel:
First by “Gel” we mean the stuff in the implant container or “shell.” The hard silicone gel “shell” that holds the contents of all breast implants is the same as the cover of other implants such as pacemakers etc. This alone has never been shown to be associated with thick capsules without one of the other things we mentioned above going on as well. When those capsules get thick, they rarely get calcified. This is relative to the “shell’s” solid silicone alone.
Silicone Gel is a non-biological filler put in the “shell” in Silicone Gel implants. It unfortunately does not stay in its container well. When you put Silicone Gel into the “shell,” we find that it weeps right through this “shell” in a process called Silicone Gel “bleed.” This is not the same with Saline-filled and Silicone Gel implants.
It is my belief that this added gel bleed contributes not only to thick capsules, but to the development of calcium deposits that make silicone gel implant capsules harder than any Saline-filled implant capsule. Those are the “glistening white shards” you see in the video from my previous post. So you can get thick capsules with any implant if other things happen, but the calcium deposition seems to be much more of a problem when you add the Silicone Gel. And this makes really hard; uncomfortably hard capsules.
The problem with these observations is that some women have had both Saline-filled and Silicone Gel implants. You never really get all the gel out of there when you remove a pair of implants. The gel as we mentioned weeps into the breast tissue as well. You get most of it out by removing the capsules with the implant. So there are cases of women who have had both types of implants having capsules. It kinda blurs the margin between the two when you are trying to keep track.
I appreciate the gals at Beauty and The Breast posting on this as it showed me that further discussion was needed. Again I am not saying Silicone Gel implants are “bad” and Saline-filled implants are “good.” I am saying that the severity of the local tissue reactions that develop with breast implants tend to be less over time with Saline-filled rather than Silicone Gel implants. This has been the summation of my experience working with them over the last 13 years. When a woman chooses to have breast implants she has to make a choice. This choice has something to do with risk tolerance. If women choose Silicone knowing this, that is of course their choice. I am mostly a Saline-filled breast implant surgeon although I do place some Silicone Gel implants as well.
John Di Saia MD
Originally posted 2008-06-30 07:30:00.
Roughly 30 years ago, Mariel Hemingway, 49, had breast augmentation surgery that jeopardized her health. Now the actress wants to warn others of the potential dangers of plastic surgery. “I actually had silicone in my blood,” said Mariel. “So I did hyperbaric oxygen treatment to turn the silicone into silicone citrate so it could pass, but it took a long time to get that out of my system.”
Entertainers can have kinda unusual ideas about science. Apparently Mariel Hemingway is no exception.
As we have discussed here before, silicone gel breast implants (especially older generation units implanted prior to cohesive gel models) have a tendency to leach silicone into the body. The body reacts to this gel and that reaction can create problems over the long term most often hardening of the breasts and severe capsule formation (capsular contracture.) While I agree that saline-filled implants are safer, some women still want silicone gel implants. I encourage them to get the cohesive gel variety (gummy bear breast implants) as they should have less of this leeching going on, but the jury is still out on the nature of tissue reactions with these newer silicone implants. Will they be any less severe than those of their less viscous predecessors? For women less risk tolerant, this Orange County plastic surgeon recommends saline-filled implants.
On Ms Hemingway’s suggestion that hyperbaric oxygen might help the body rid itself of silicone gel, I would be more prone to recommend a thorough removal of the implants and their scar capsules. While silicone gel can travel to distant sites, this is far more rare than concentration in the local tissues. Hyperbaric oxygen is not a proven treatment for silicone removal.
Scar capsules of older silicone implants (older meaning non cohesive gel units) can look like something from a Sigourney Weaver flick. If you have older silicone implants, my recommendation is usually to remove and/or replace them and certainly have the capsules removed as completely as possible in the process. The safe replacement interval for cohesive gel units has yet to be determined, but ten years would be a reasonable guess-ti-mate.
John Di Saia MD
This 60 year old lady had had silicone gel breast implants for thirty years. Over this time her breasts changed slowly and she barely noticed the progression to the rock hard things they had become (lower left of our image.) She came for consultation to have the hardened implants removed, but wondered if not replacing them would leave her more deformed.
Her pre-operative image (lower left) shows capsular contracture with high positioning of the implants forced by the scarring that had occurred over the many years they had been in place. Minimal correction in this case involved removing the implants without replacement and also carefully removing the scar capsules themselves so the breasts could appear more natural. Breast lifting could have been added but the patient did not desire it. She had plenty of normal breast tissue to fill in the area without leaving a deformity. She was quite happy afterward with softened normal looking breasts and no implants.
John Di Saia MD
As the story goes Kimberly Stewart had breast implant surgery years ago and later had them removed over “health fears.” As she was smoking at the time and they were large (relative to her slight frame) I’d bet they were affected by capsular contracture and this may have scared her. A short YouTube video I made of a breast implant removal operation in a woman affected by a severe case of this breast hardening is posted below. This seems to affect patients who smoke and patients who have silicone gel implants more commonly.
After her removal operation, Kimberly gave her implants to Jack Osbourne who framed them and put them on his wall. Touching. It looks like she also had a nose job that worked out better for her.
John Di Saia MD
Originally posted 2009-11-04 07:30:02.
I am asked pretty regularly about what a woman should do with old breast implants. The answer depends upon how things look and feel and what kind of implants are in place. Silicone gel implants in my opinion should be changed more frequently.
Silicone gel implants degrade over time and our bodies react with the gel creating scar and calcium. This hardens the breasts and requires removal of the implants and capsules to repair. This is amongst my reasons for preferring saline filled implants as they cause much less of this reaction than the silicone gel implant types. Newer generation gummy bear silicone gel implants will hopefully cause less reaction than their predecessors, but we won’t know how much for about another 10 years.
The images on the next page are those from a recent case in which I removed 25 year old silicone breast implants and the scar capsules that surrounded them. In this case the patient didn’t realize that her right implant was ruptured until an imaging study was obtained. In addition, since her breasts had hardened slowly over years, she didn’t connect it with her implants.
John Di Saia MD
Originally posted 2010-04-28 07:30:32.
“Tabatha Coffey has made some claims in her new book about her breast augmentation surgery. First she claims that her implant ruptured an artery. If this had happened wouldn’t she have bled to death by the time she went in for surgery to remove her implants? She also claimed that the implant moved from her chest to her arm pit then onto her shoulder. Is it even possible for an implant to travel up onto your shoulder?”
Gold Coast-born hair stylist Tabatha Coffey – star of US reality TV show Tabatha’s Salon Takeover which is screened on pay TV channel ARENA in Australia – said her implant apparently ruptured an artery and infected her chest. “I had lusted after bigger boobs for years, and then they almost killed me,” the bitchy and foul-mouthed star said. Days after the surgery, her left breast moved up under her arm and onto her shoulder. After extreme pain, she had the implants removed.
Part of this story is likely true, but exaggeration is pretty much certain. Although patients can bleed after breast implant surgery, no one that I have seen or read about has ever died from this. The implants didn’t rupture her artery. It is more far more likely that bleeding occurred after surgery for reasons relating to the operation. Implant migration can happen more commonly with larger implants and/or inexperienced surgeons. Much of this would be more understandable if she turned out to be a smoker. Breast hardening (capsular contracture) and pain after implant placement are more common in smokers and even more common in smokers with bleeding complications.
John Di Saia MD
What are the side effects of repetitive breast implant surgery? Does it increase the risks of capsular contracture? What is the recommended maximum amount of breast surgery that can be performed before things go wrong?
Plastic surgery is an interface between art and science, so there are few absolute answers. We do know that repeated surgery on a woman’s breasts can decrease sensitivity as more and more breast tissue tends to be replaced by scar tissue. This is a tendency though and not an absolute. Good judgment is needed when trying to determine when it is a good idea to return to surgery on a breast implant patient. It is a matter of risk versus benefit.
Capsular contracture is the result of the scarring around the implants. It can be increased by genetic tendencies, silicone gel implants, larger implants, radiation treatment and cigarette smoking.
These are amongst the reasons that breast implant surgery is best performed by experienced well-trained individuals…to try to minimize these risks where possible and to guide you in the decision to operate or not.
John Di Saia MD
Originally posted 2009-08-06 07:30:31.